DISCLOSURES Impairments in People with Acquired Brain Injury - - PDF document

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Summary of Evidence Based Interventions for Treatment of Cognitive Impairments in People with Acquired Brain Injury

REBECCA D. EBERLE, M.A., CCC-SLP, BC-ANCDS CLINICAL ASSOCIATE PROFESSOR

April 25, 2015

DISCLOSURES

Rebecca D. Eberle, M.A., CCC-SLP, BC-ANCDS Has no financial or other interest to disclose Learning Objectives

• Define the acquisition, application and adaptation stages
• f cognitive rehabilitation
• Write specific short-term tactical goals for cognitive

rehabilitation clearly linked to long-term strategic goals and the ACRM evidence-based recommendations

• Employ a decision-tree to assist in determining the most

appropriate cognitive rehabilitation intervention to implement

• Identify the key intervention approaches for impairments
• f attention, memory, executive functions and social

communication, based on the literature of evidenced based practices.

Evidence-Based Cognitive Rehabilitation: Recommendations

 Cicerone et al, Arch Phys Med Rehab, 2000, 2005 and 2011  Researchers (Cognitive Rehabilitation Task Force

• f ACRM BI-ISIG) pursued comprehensive and

methodical review of 370 articles (from 1971-2008) to derive 3 types of recommendations:

• Practice Standards
• Practice Guidelines
• Practice Options
• Did also state “Not recommended”

Classification of Level of Evidence

Class I/Ia (N = 65) Studies with well designed, prospective, randomized controlled trials Class II (N = 54) Prospective, nonrandomized cohort studies;

• r clinical series with well-designed controls

that permitted between subject comparisons

• f treatment conditions

Class III (N = 251) Clinical series w/o concurrent controls, or studies with results from 1 or more single cases w/ appropriate methods

Cicerone et al, 2000, 2005 & 2011 combined Recommendation Description – as to whether the treatment be specifically considered for persons with neurocognitive impairments and disability Practice Standard Based on at least 1 well-designed class I study with an adequate sample, with support from class II/III evidence; providing substantive evidence to support a recommendation. Practice Guideline Based on 1 or more class I studies with methodologic limitations, or well-designed class II studies with adequate samples; providing evidence for probable effectiveness to support a recommendation. Practice Option Based on class II or class III studies that directly address the effectiveness of a treatment, providing evidence of possible effectiveness to support a recommendation. Cicerone et al, 2000, 2005 & 2011

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Levels of Recommendation for Rehabilitation Strategies

• Practice Standard: “substantial evidence”
• Practice Guideline: “probable effectiveness”
• Practice Option: “possible effectiveness” but

requires further research

Cognitive Rehabilitation Manual (2012)

• Based on the systematic reviews (Cicerone et

al., 2000, 2005, 2011)

• First draft by Ed Haskins, Ph.D.
• Edits, additions and revisions made by

members of the ACRM Cognitive Rehabilitation Manual Sub-Committee. Externally-reviewed by 24 novice to expert therapists and subsequent

• revisions. Reviewed by the Clinical Practice

Committee of ACRM.

• Final version available in April 2012
• Clinical methods not often described in sufficient

detail

• Practitioners do not have easy access to literature or

time to read literature

• Training programs for practitioners do not include BI

specific cognitive rehabilitation strategies

• Rehabilitation organizations have reduced training

budgets

• Staff turnover results in experience drain

Barriers to Translation of Research into Clinical Practice Goals of Cognitive Rehabilitation

• “…ameliorate injury-related deficits in order to

maximize safety, daily functioning, independence and quality of life”

• Achieved in a step-wise manner with emphasis on

4 long term goal areas:

• Problem orientation, awareness and goal

setting

• Compensation
• Internalization
• Generalization

Problem Orientation, awareness and goal setting

• Recognizing specific problem(s) that require

intervention

• Collaborating to establish meaningful short- and

long-term goals

• Awareness and goal setting is a major

therapeutic priority; foundation for most intervention

Compensation

• Providing clients with the necessary tools
• Positively impacts functioning despite

persistent or chronic impairments

• Often the end goal for cognitive rehabilitation
• Examples:
• External memory aids
• External templates for decision making

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Internalization

• The clinical process of gradually

increasing the automaticity of practiced strategies which facilitates independence through the use of compensatory strategies and tools.

Generalization

• Application of appropriate strategies for

managing deficits in personally relevant areas of everyday functioning

Stage of Treatment: Goals: Type of Strategies Used:

Acquisition

• 1. teach purpose and procedures of

treatment model

• 2. help patient recognize and accept

deficits and benefits of treatment External

Application

• 1. improve effectiveness &

independence in compensating for deficits

• 2. promote internalization of

strategies

• 1. External
• 2. Internal

Adaptation

• 1. promote transfer of training to tasks

including those that are less structured, more novel, complex, and/or distracting

• 2. promote generalization of skills

from the structured therapy setting to less structured environments such as home, community, and work

• 1. External and Internal
• 2. External and Internal

Sohlberg & Mateer, 2001

Stages of Cognitive Rehabilitation

External Versus Internal Strategies

External

• Those external to the

patient; e.g. use of notebooks, electronic devices, cue cards…

• LTG of external strategies

is to enable patient to compensate for their impairments INDEPENDENTLY by using aids. Internal

• Any self-generated

procedure whose purpose is to enhance conscious control over thoughts behaviors or emotions.

• LTG of internal strategies is

to enable patient to become so familiar/adept with process they can use it globally and without external assistance

Patient Progress Outcomes

• 1. Patient never develops necessary awareness

to compensate; patient learns to perform simple routine and action sequences procedurally

• 2. Patient independent with use of external aids;

some internalization, but still needs external guidance

• 3. Patient able to internalize fully-learned

strategies; can apply in specific situations or tasks.

• 4. Patient generalizes learned skills to a range of

situations and/or tasks.

Treatment Planning and Goal Writing

Treatment planning and goal setting is a collaborative process. Essential Ingredients:

• Objective measurement of progress on short-

term tactical goals,

• Collaborative appraisal of progress, and
• Constructive counseling

Very important to assist the patient in modifying goals and sustain motivation and engagement in the therapeutic process

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Writing Short-term (tactical) & Long-term (Strategic) Goals

• Writing & measuring short-term tactical goals

Quantification essential! The more specificity the behavioral feedback the faster behavior changes

• Monitor and chart (daily, weekly, monthly) the

patient’s progress

• Promote patient engagement in quantification
• Enhance motivation for treatment

Writing Short-term (tactical) & Long-term (strategic) Goals

• LT (Strategic) Goal: “improve ability to

independently compensate for memory deficits using external aids”

• ST (Tactical) Goal: “patient will initiate four

simple household tasks on a daily basis with minimal assistance using a memory notebook”

Comprehensive Template for Goal Writing

Five Essential Factors Example “Patient will perform…. Type of Task household tasks that require scheduling Complexity of Task that are simple Level of Cueing or Assistance Needed with minimal assistance Type of Strategy Employed to use a memory notebook strategy Measurement of Performance (e,g., speed, accuracy) at 100% accuracy.”

Treatment Considerations when Designing Training Procedures

Task specific vs. general approaches

– Task specific protocols focus on procedural learning for a specific task (e.g., medication) – General Approaches are broad and aimed at an

• verall domain (e.g.,

memory)

External vs. Internal Strategies

–Memory Mnemonics (Internal) –Procedural (External) –Impairment Level

• Mild: benefit from

both

• Severe: tend to

benefit from external

Is Patient Aware of Deficits? Can Patient Use Notebook

• r Electronic Device with

Assistance? What is patient’s level of impairment? Use Techniques to Increase Awareness Use Task Specific Approach: Errorless Learning, Spaced Retrieval, Chaining Use External Strategies

• nly: Provide Cueing

and Assistance No No Yes Yes Continue to use External Strategy with Assistance, if Needed Mild/Mod Severe Use Internalized Strategies, as able Use both, as needed Use both, as needed And

Neurobehavioral and Psychosocial Factors that Influence Process and Outcome

• Patient Variables
• Values and Priorities
• Coping skills
• Self-worth and self-

efficacy

• Awareness
• Anosognosia
• Domain-specific
• Brain Injury

Knowledge

• Severity and Range of

Impairment

• Emotional Reactions
• Premorbid Psychiatric

issues

• Family Factors

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Monitoring Cog. Rehab. Progress

Specific task data “Big Picture” Progress

References

• Cicerone, K., Dahlberg, C., Kalmar, K., Langenbahn, D., Malec, J.,

Bergquist, T. et al (2000) Evidence based cognitive rehabilitation: Recommendations for clinical practice. Archives of Physical Medicine and Rehabilitation, 81, 1596-1615

• Cicerone, KD, Dahlberg, MA, Malec, JF, Langenbahn, DM, Felicetti,

Kneipp, S, Ellmo, W, Kalmar, K, Giacino, JT, Harley, JP, Laatsch, L, Morse, PA, Catanese, J. (2005) Evidenced based cognitive rehabilitation: updated review of the literature from 1998 to 2002. Archives of Physical Medicine and Rehabilitation, 86, 1681-1692.

• Cicerone KD, Langenbahn DM, Braden C, Malec JF, Kalmar K, Fraas

M, Felicetti T, Laatsch L, Harley JP, Bergquist T, Azulay J, Cantor J, Ashman T., Ph.D. (2011) Evidence-Based Cognitive Rehabilitation: Updated Review of the Literature from 2003 through 2008. Archives

• f Physical Medicine and Rehabilitation, 9,519-530.
• Sohlberg, M.A. & Mateer, C.A. (1989) Introduction to Cognitive

Rehabilitation Theory and Practice. New York: Guilford Press.

What does the research recommend for cognitive interventions?

• Executive Function
• Attention
• Memory
• Social Communication

Executive Functioning??

• The integrative cognitive processes that

determine goal-directed and purposeful behavior

• Includes abilities to:

Formulate goals and solve problems Anticipate the consequences of actions Plan and organize behavior Initiate relevant behaviors Monitor and adapt behavior to fit a particular task or context

Executive Functions and Brain Dysfunction

• Cognitively - Problems with awareness,

anticipating problems, analyzing situations, planning solutions, executing those solutions, maintaining a flexible approach to tasks, and monitoring themselves.

• Behaviorally- fail to think before they act,

impulsivity or disinhibition, initiation deficits, hyperverbosity, poor emotional control and cognitive inflexibility.

BI-ISIG Recommendations for the Treatment of Executive Dysfunction

Practice Standard: Metacognitive strategy training (self-monitoring and self-regulation) for deficits in executive functioning after TBI, including impairments in emotional self-regulation, and as a component

• f interventions for deficits in attention, neglect

and memory

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BI-ISIG Recommendations for Treatment

• f Executive Dysfunction (cont’d)

Practice Guideline: Training in formal problem-solving strategies and their application to everyday situations and functional activities during post-acute rehabilitation after TBI Practice Option: Group-based interventions may be considered for remediation of executive and problem-solving deficits after TBI

Bottom-up Approaches

• Restorative
• Repetitive practice

exercises and drills

• Task-specific
• e.g., attention training

Top-Down Approaches

• Compensatory
• Learning and use of

strategies

• Generalize to many

contexts

• e.g., problem solving

training

Is Patient Aware of Deficits? Can Patient Use a Formal Problem solving External Strategy? What is patient’s level

• f impairment?

Use Techniques to Increase Awareness Use Task Specific Approach: Errorless Learning, Spaced Retrieval, Chaining Use External Strategies only: Provide Cueing and Assistance No No Yes Yes DECISION TREE FOR TREATMENT PLANNING FOR EXECUTIVE DYSFUNCTION Continue to Use External Strategy with Assistance, if Needed Mild/ Mod Severe Use Internalized Strategies, as Able Use both, as needed Use both, as needed

Examples of Formal Problem Solving Models

• Ylvisaker and Feeney, 1998:

Goal/Plan/Do/Review

• Levine et al., 2000:

Stop/Define/List/Learn/Check

• Lawson and Rice, 1989:

What/Select/Try/Check

Major Factors in Formal Problem Solving Models

• Patient is trained to use a structured

sequence when addressing a problem. Awareness Anticipate/Plan Execute/Monitor Self Evaluate

Sample Formats

• Goal Management Training - template
• Goal Plan Do Review – template
• Goal Plan Do Review - expanded
• Goal Plan Do Review – sample

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Targets of Metacognitive Strategy Training for Behavioral Dysregulation

• Awareness
• Impulsivity
• Disinhibition
• Anger Management
• Perseveration

Major Features of Metacognitive Strategy Training for Executive Deficits

• Internally controlled: The timing and execution
• f the strategies are self-generated by the

patient and under the control of internal cognitive processes.

• This is in contrast with strategies under

external control, i.e., under the control of a therapist or caretaker.

Major Features of Metacognitive Strategy Training for Executive Deficits

• Generalizable
• Individualized and contextualized (“real-

world” problems)

• Personally relevant
• Internally controlled: self-generated
• Rely on practice and repetition

Hierarchy of Attention

Focused Sustained Selective Alternating Divided

BI-ISIG Recommendations for the Treatment of Attention Impairments

Practice Standard:

• Remediation of attention during post-acute

rehabilitation after TBI.

• Remediation of attention deficits after TBI should

include:

DIRECT ATTENTION TRAINING STRATEGY TREATMENT OF ATTENTION DEFICITS

BI-ISIG Recommendations for the Treatment of Attention

Practice Option: computer-based intervention may be considered as an adjunct to clinician-guided treatment for the remediation

• f attention; sole reliance on computer-based tasks

without some involvement and intervention by a therapist is not recommended.

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Attention Process Training (APT): Foundation

• Hierarchically organized, clinical theory of

attention.

• APT I, II, III
• 5 different tracks:

ATTENTION FOCUSED SUSTAINED SELECTIVE ALTERNATING DIVIDED

Attention Process Training (APT): Generalization Activities

Example: Alternating Attention

Naturalistic Setting Functional Task Residential Cooking while monitoring the washer/dryer cycles Vocational Switching between phone and typing task Community Transportation: walking while consulting map

(Sohlberg et al., 2001)

Time Pressure Management (TPM) Training: Foundation

• Compensates for mental slowness.
• Utilizes a structured problem-solving strategy to

assist in regulating information input.

• Can be applied to the treatment of attention,

memory, problem solving, and apraxia.

• Includes strategies to both prevent and manage

time pressure.

Application of TPM – Trip Planning

Strategic level

• Preventing time pressure
• Analyzing situation for time

pressure

• Anticipation and planning

Tactical level

• Preventing and managing

pressure

• Anticipation and planning
• Execution and self-monitoring

Operational level

• Managing overwhelming time

pressure

• Execution and self-monitoring
• Emergency plan
• Self evaluation

Actions

• Far in advance - Research and

book hotel, airfare, car rental

• Week before -check forecast, make

travel arrangements (to/from airport), purchase last minute items (ex: sunscreen), make packing list

• Day before – check in/print

boarding pass, finish packing, confirm travel arrangements,

• rganize money, ID, carry on items
• Day of – wear slip on shoes, have

ID and boarding pass easily accessible, leave extra time

• At airport – ask an employee for

help; have airline contact information accessible

Clinical Assumptions of Working Memory Rehabilitation

• Attention problems become more pronounced in

situations that demand attention to rapidly presented information and/or multiple sources of information

• Attention can be improved by addressing underlying

problems with working memory

• Patients can be taught to use strategies to help

allocate attention resources and manage the rate of information processing

(Cicerone, 2002)

Level 1: N-Back Procedures

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Level 1: N-Back Procedures

Working Memory Training: Strategies

Strategies

Verbal Mediation Rehearsal Self- pacing Sharing attentional resources Self- monitoring Managing emotional reactions

Components of Memory

Attention Encoding Storage Retrieval

(Sohlberg & Mateer, 2001)

BI-ISIG Recommendations for Treatment of Memory Deficits

Practice Standard: Memory strategy training is recommended for mild memory impairments from TBI, including the use of internalized strategies (e.g., visual imagery) and external memory compensations (e.g., notebooks). Practice Guideline: Use of external compensations with direct application to functional activities is recommended for people with severe memory deficits after TBI or stroke.

BI-ISIG Recommendations for Treatment of Memory Deficits

Practice Options:

• For people with severe memory impairments after TBI,

errorless learning techniques may be effective for learning specific skills or knowledge, with limited transfer to novel tasks or reduction in overall functional memory problems.

• Group-based interventions may be considered for

remediation of memory deficits after TBI.

Is Patient Aware of Deficits? Can Patient Use Notebook

• r Electronic Device with

Assistance? What is patient’s level of impairment? Use Techniques to Increase Awareness Use Task Specific Approach: Errorless Learning, Spaced Retrieval, Chaining Use External Strategies

• nly: Provide Cueing

and Assistance No No Yes Yes Continue to use External Strategy with Assistance, if Needed Mild/Mod Severe Use Memory Strategy Training Use both, as needed Use both, as needed And

Decision Tree for Treatment Planning In Memory Dysfunction

Cognitive Rehabilitation Manual, Figure 3.1

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Considerations in Choosing a Strategy• Severity of impairment

• Nature of the information to be

remembered

• Functional, personally meaningful

tasks

• Patient should understand, have

input into goals and strategies- active collaboration.

Types of External Devices

• Notebooks
• Other written planning systems
• Electronic planners, PDA’s
• Smart cell phones
• Computerized systems
• Auditory or visual systems
• Task-specific aids

Which Type of External Device?

1. The particular task the patient wishes to perform 2. The patient’s goals, abilities, disabilities and preferences 3. The physical features (or limitations) of available technology: audio features, digital

• ptions, cost, downloadable apps

4. The environment in which technology is going to be used. 5. The familiarity to the patient.

General Guidelines for External Memory Strategies

• Constant and easy access to the external device or

notebook.

• Training of all staff and family members in the use of

device.

• Errorless learning techniques and use of procedural

memory for severely impaired patients.

• Multiple learning & generalization trials.

Memory Notebook

• Comprises the core of external memory

compensations, along with electronic devices.

• Possible sections:

Things to do Memory log Daily schedule Homework History and background Handouts Contacts

Stages in Memory Notebook Training

Goal: To use notebook in naturalistic settings Strategies: Feedback, cues, repetition, updating

Adaptation

Goal: To use notebook on functional tasks in clinic Strategies: Feedback, cues, repetition

Application

Goal: To learn the names, purpose, & use of each section Strategies: Errorless learning, spaced retrieval

Acquisition

(Sohlberg & Mateer, 2001)

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Strategies for Severe Memory Impairment: Overview

• Appropriate for clinically important functional skills

training, e.g., safe transfers

• Domain specific learning; limited generalization
• Attempts to maximize functioning through recruitment of

procedural memory

Effective Strategies for Severe Impairment

Errorless Learning Chaining Spaced Retrieval

Errorless Learning

• Presents information in a way that minimizes the

possibility of making mistakes.

• Therapist presents simple information, and

requests the patient to immediately repeat.

• More effective when combined with spaced

retrieval or with chaining techniques.

Memory Strategy Training

• Internal, self-instructional strategies for storage

and retrieval of declarative information. Verbal or non-verbal Can be facilitated by external strategies

• Most effective for those with mild to moderate

memory impairments

Memory Strategy Training

Encoding strategies Retrieval strategies Enhance patient’s ability to find and retrieve information at the time of recall

New Information Known Information Cues

Types of Metacognitive Techniques

Association Elaboration Organizational

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Association Techniques

Technique Description Visual Peg Method Target items are linked with a standard set of peg words which are already learned in a set sequence. Method of Loci Linking information to specific (external) visual reference Visual Imagery Linking information to specific (internal) visual reference Absurdity Humor and high levels of interaction make associations stronger

Organizational Techniques

Technique Description First Letter Mnemonics Use the first letter of each of a series of words to form a single word or pseudo-word. HOMES = Huron Ontario Michigan Erie Superior Semantic Clustering Grouping items in a list into smaller categories PQRST Self-instructional technique to learn and recall complex written information P review Q uestion R ead S tate T est

Deficits in Social Communication

• Impact success with: Communicating needs and

thoughts

• Listening and understanding others
• Giving and interpreting nonverbal

communication

• Regulating emotions in social interactions
• Following social boundaries and rules
• Working with others to solve tasks, and
• Being assertive

(Hawley & Newman, 2006)

Impact into daily life

• Fewer employment opportunities
• Poorer quality of life, decrease in life

satisfaction

• Problems in social relationships
• Reduced community integration with social

isolation

• Higher risk for depression

What the Evidence Supports: Recommendations by ACRM BI-ISIG

Practice Standard “Specific interventions for functional communication deficits, including pragmatic conversations skills, are recommended for social communication skills after TBI” Practice Option “Group based interventions may be considered for remediation of language deficits after left hemisphere stroke and for social-communication deficits after TBI.”

Cicerone et al 2011

Translating Directly Into Clinical Practice

• Group Treatment specific to social communication

deficits

• Specific treatments for emotion perception deficits

Errorless learning Self-Instructional training

• Individual psychotherapy, supplementing group

based treatment programs

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Group Treatment for Social Communication Deficits

• Hawley & Newman (2006, 2008, 2010)

Group Interactive Structured Treatment-GIST: for Social Competence, Hawley and Newman, (2006, 2008), www.braininjurysocialcompetence.com

• McDonald and colleagues (2008)

Improving First Impressions: A Step-by-Step Social Skills Program, McDonald et al., (2009), http://www2.psy.unsw.edu.au/Users/Smcdonald/resources.html

Group Treatment Applied to Social Communication Deficits

• Group Process
• Individual Goal Setting
• Feedback
• Practice and Repetition
• Self-Monitoring
• Generalization of Skills

Dahlberg et al, 2007, McDonald et al, 2008

Tx of emotion perception deficits

• Aim = improve ability to recognize & interpret others’

nonverbal cues – facial expressions, affective tone, gestures, body posture, proximity.

• In learning, cues are hierarchically organized:

Knowledge base

• conventional emotional contexts
• Emotions associated with particular scenarios
• Discriminating between similar or co-occurring emotions (e.g.

anger/disappointment;

Judge static emotional cues from line drawings, then photographs, to videos Presented in one modality (i.e. visual) —› multiple modalities (i.e. visual and auditory)

• Final goals include making social inferences about

speaker’s intentions, truthfulness, emotional state; interpretation of situational cues.

Treating Deficits in Emotion Perception After TBI

Bornhofen & McDonald, 2008a, 2008b

• Interpreting conventional emotional contexts (birthday party)
• Judging static visual emotion cues
• Judging dynamic emotional cues
• Therapist modeling
• Role play and videotaping
• Making social inferences based on emotional demeanor and

situational cues

• Start with easy

discriminations

• Extensive practice
• Discourage guessing if

unsure

• For example: “Wide eyes

and raised eyebrows in surprise”

• Video example:

Photo labeling

Bornhofen & McDonald, 2008

Self-Instructional Training in Treating Emotional Perception Deficits

• Verbalization of procedural steps.
• Learn to use self-guided statements to

intensify attention, discriminate emotions, make decisions and correct errors.

• Assist with making social inferences on

dynamic emotional and situations cues.

• Used toward end of treatment; key skills

established

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Self-Instructional Training

• Acronym – WALTER

1. What am I deciding about? 2. What do I Already know about it? 3. What do I need to Look/Listen for? 4. Try out my answer. 5. Evaluate how it went. 6. Reward myself for having a go! Bornhofen & McDonald, 2008; delineated by Meichenbaum and Cameron, 1973

References – Executive Functions

• Alderman, N., Fry, R., & Youngson, H. (1995) Improvement of

self-monitoring skills, reduction of behavior disturbance and the dysexecutive syndrome: Comparison of response cost and a new programme of self-monitoring training. Neuropsychological Rehabilitation, 5, 193-221.

• Fleming, J. & Ownsworth, T. (2006) A review of awareness

interventions in brain injury rehabilitation. Neuropsychological Rehabilitation, 16, 474-500.

• Goverover, Y., Johnston, M., Toglia, J., & DeLuca, J. (2007)

Treatment to improve self awareness in persons with acquired brain injury. Brain Injury, 21, 913-923.

• Sohlberg, M. & Mateer, C. (2001) Cognitive Rehabilitation: An

Integrative Neuropsychological Approach. New York: The Guilford Press.

References – Executive Functions

• Lawson, M. & Rice, D. (1989) Effects of training in the use of

executive strategies on a verbal memory problem resulting from closed head injury. Journal of Clinical and Experimental Neuropsychology, 11, 842-854.

• Levine, B., Robertson, I, et al (2000) Rehabilitation of executive

functiong: An experimental-clinical validation of Goal Management Training, Journal of the International Neuropsychological Society, 6, 299-312.

• Meichenbaum, D.H., & Goodman, J (1971). Training impulsive

children to talk to themselves: A means of developing self-

• control. Journal of Abnormal Psychology, 77, 115-126.
• Sohlberg, M. & Mateer, C. (2001) Cognitive Rehabilitation: An

Integrative Neuropsychological Approach. New York: The Guilford Press.

• Ylvisaker, M. & Feeney, T. (1998) Collaborative Brain Injury

Intervention: Positive Everyday Routines. San Diego: Singular.

References - Attention

• Cicerone, K. (2002) Remediation of working attention in mild

traumatic brain injury. Brain Injury, 16, 185-195.

• Fasotti, L., Kovacs, F., Eling, P., & Brouwer, W. (2000) Time

pressure management as a compensatory strategy training

• after closed head injury. Neuropsychological Rehabilitation, 10,

47-65.

• Sohlberg, M., Johnson, L., Paule, L., Raskin, S. & Mateer, C.

(2001) Attention Process Training II: A program to address attentional deficits for persons with mild cognitive dysfunction. Puyallup, WA: Lash & Associates Publishing/Training Inc.

• Winkens, I., Van Heugten, C., Wade, D., & Fasotti, L. (2009)

Training patients in Time Pressure Management: A cognitive strategy for mental slowness. Clinical Rehabilitation, 23, 79-90.

References - Memory

• Donaghy S, and Williams W. A new protocol for training severely impaired

patients in usage of memory journals. Brain Injury, 12: 1061-1076, 1998.

• Ehlhardt LA, Sohlberg MM, Gland A, & Albin R. TEACH-M: A pilot study

evaluating an instructional sequence for persons with impaired memory and executive functions. Brain Injury 19:569-583, 2005.

• Evans JJ, Wilson BA, Schuri U, et al. A comparison of errorless and trial-and-

error learning methods for teaching individuals with acquired memory deficits. Neuropsychological Rehabilitation 10: 67-101, 2000.

• Kaschel R, Della Sala S., Cantagallo A, et al. Imagery mnemonics for the

rehabilitation of memory: A randomised group controlled trial. Neuropsychological Rehabilitation 12: 127-153, 2002.

• Ownsworth T, and McFarland K. Memory remediation in long term acquired brain

injury: Two approaches in diary training. Brain Injury, 13: 605-626,1991.

References - Memory

• Sohlberg M. and Mateer C. Cognitive Rehabilitation: An

Integrative Neuropsychological Approach. New York: The Guilford Press, 2001.

• Sohlberg M, Ehlhardt L, & Kennedy, M. Instructional

techniques in cognitive rehabilitation: A preliminary report. Seminars in Speech and Language 26: 268-279, 2005.

• Thickpenny-Davis KL, & Barker-Collow SL. Evaluation of a

structured group format memory rehabilitation program for adults following brain injury. Journal of Head Trauma Rehabilitation 22: 303-313, 2007.

• Wilson B. Memory Rehabilitation: Integrating Theory and
• Practice. New York: Guilford Press, 2009.

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References – Social Communication

• Hawley, L, Newman, J. Group Interactive Structured

Treatment (GIST): A social competence intervention for individuals with brain injury. Brain Injury 24(11): 1292-1297, 2010.

• Meichenbaum D, and Cameron R. Training schizophrenics

to talk to themselves: a means of developing attentional

• controls. Behavioral Therapy 4(4): 515-534, 1973.
• McDonald S, Tate R, and Togher, L, et al. Social skills

treatment for people with severe, chronic acquired brain injuries: A multicenter trial. Archives of Physical Medicine and Rehabilitation 89:1648-1659, 2008.

References – Social Communication

• Dahlberg CA, Cusick CP, and Hawley LA et al. Treatment

efficacy of social communication skills training after traumatic brain injury: A randomized treatment and deferred treatment controlled trial. Archives of Physical Medicine and Rehabilitation 88:1561-1573, 2007.

• Flanagan S, McDonald S, and Togher L. Evaluation of the

BRISS as a measure of social skills in the traumatically brain injured. Brain Injury 9:321-38, 1995.

• Hawley L, Newman J. Social skills and traumatic brain

injury: a workbook for group treatment. Denver: authors; 2006.

Test References - Social Communication

• Green REA, Turner GR, Thompson WF. Deficits in facial emotion

perception in adults with recent traumatic brain injury. Neuropsychologia 42(4): 133-141, 2004.

• Hornak J, Rolls E, Wade D. Face and voice expression

identification in patients with emotional and behavioural changes following ventral frontal lobe damage. Neuropsychologia 34(4): 247- 261, 1996.

• McDonald S, Flanagan S, Rollins J, Kinch J. TASIT: A new clinical

tool for assessing social perception after traumatic brain injury. Journal of Head Trauma Rehabilitation 18: 219-238, 2003.